Transconjunctival mitomycin-C in needle revisions of failing filtering blebs.

Abstract

To report the efficacy and safety of transconjunctival mitomycin-C as an adjunct to needle revision of failing filtering blebs. Retrospective, consecutive, noncomparative interventional case series. Forty-one patients (42 eyes) undergoing bleb revisions by a single surgeon at a single institution from May 1997 to January 2001. The authors retrospectively reviewed charts of 42 eyes that underwent needle revision of the failing filtering bleb using transconjunctival application of mitomycin-C. Needling of the bleb was performed with a 25-gauge needle. The site of the needle puncture was sutured and followed by application of transconjunctival mitomycin-C (0.5 mg/ml) by means of a sponge left in contact with the conjunctival epithelium for 6 minutes. A group of patients received additional subconjunctival injections of 5-fluorouracil in the postoperative period. Success was defined as a reduction in intraocular pressure of 30% without the use of antiglaucoma medications and no further surgical procedures to control intraocular pressure. Intraocular pressure, visual acuity, complications, number of glaucoma medications used at the final visit. Mean preoperative intraocular pressure was 22.1 +/- 8.0 mmHg, which was reduced by 9.6 +/- 7.9 mmHg to a mean postoperative intraocular pressure of 12.5 +/- 6.1 mmHg. Mean follow-up was 17.6 +/- 13.5 months. Kaplan-Meier survival analysis showed a probability of continued success at 12 months of 76.1%, and at 24 months of 71.6%. The most common complication was hyphema in 7.1% of patients. Twenty-six eyes also received postoperative injections of 5-fluorouracil. Transconjunctival mitomycin-C may enhance success of the needling procedure in failing filtering blebs.